Impact of mitral regurgitation in patients with acute heart failure: insights from the RELAX-AHF-2 trial
Matteo Pagnesi
Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Contributed equally.
Search for more papers by this authorMarianna Adamo
Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Contributed equally.
Search for more papers by this authorJozine M. ter Maaten
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorIris E. Beldhuis
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorG. Michael Felker
Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
Search for more papers by this authorGerasimos Filippatos
Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
Search for more papers by this authorBarry H. Greenberg
Division of Cardiology, University of California San Diego, San Diego, CA, USA
Search for more papers by this authorPeter S. Pang
Department of Emergency Medicine, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, IN, USA
Search for more papers by this authorPiotr Ponikowski
Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
Search for more papers by this authorIziah E. Sama
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorAdriaan A. Voors
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorJohn R. Teerlink
Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
Search for more papers by this authorCorresponding Author
Marco Metra
Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Corresponding author. Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 335 6460581, Fax: +39 030 3700359, Email: [email protected]
Search for more papers by this authorMatteo Pagnesi
Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Contributed equally.
Search for more papers by this authorMarianna Adamo
Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Contributed equally.
Search for more papers by this authorJozine M. ter Maaten
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorIris E. Beldhuis
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorG. Michael Felker
Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
Search for more papers by this authorGerasimos Filippatos
Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
Search for more papers by this authorBarry H. Greenberg
Division of Cardiology, University of California San Diego, San Diego, CA, USA
Search for more papers by this authorPeter S. Pang
Department of Emergency Medicine, Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, IN, USA
Search for more papers by this authorPiotr Ponikowski
Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
Search for more papers by this authorIziah E. Sama
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorAdriaan A. Voors
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Search for more papers by this authorJohn R. Teerlink
Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
Search for more papers by this authorCorresponding Author
Marco Metra
Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
Corresponding author. Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Tel: +39 335 6460581, Fax: +39 030 3700359, Email: [email protected]
Search for more papers by this authorAbstract
Aims
The impact of mitral regurgitation (MR) in patients hospitalized for acute heart failure (AHF) is not well established. We assessed the role of MR in patients enrolled in the Relaxin in Acute Heart Failure 2 (RELAX-AHF-2) trial.
Methods and results
Patients enrolled in RELAX-AHF-2 with available data regarding MR status were included in this analysis. Baseline characteristics, in-hospital data, and clinical outcomes through 180-day follow-up were evaluated. The impact of moderate/severe MR was assessed. Among 6420 AHF patients with known MR status, 1810 patients (28.2%) had moderate/severe MR. Compared to patients with no/mild MR, those with moderate/severe MR were more likely to have history of heart failure (HF), prior HF hospitalization, more comorbidities, symptoms/signs of HF, lower left ventricular ejection fraction and higher N-terminal pro-B-type natriuretic peptide levels. Moderate/severe MR was associated with longer length of hospital stay, higher rates of residual dyspnoea, increased jugular venous pressure through the index hospitalization and a higher unadjusted risk of the composite of cardiovascular (CV) death or rehospitalization for HF/renal failure (RF) through 180 days (crude hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.03–1.27, p = 0.01). The association between moderate/severe MR and poorer outcomes was not maintained in a multivariable model including several covariates of interest (adjusted HR 1.03, 95% CI 0.91–1.17, p = 0.65). Similar findings were observed for HF/RF rehospitalization alone.
Conclusions
In patients with AHF, moderate/severe MR was associated with a worse clinical profile but did not have an independent prognostic impact on clinical outcomes.
Graphical Abstract
Impact of mitral regurgitation (MR) in patients with acute heart failure (HF): an analysis on 6420 patients from RELAX-AHF-2. AF, atrial fibrillation; BNP, B-type natriuretic peptide; CI, confidence interval; COPD, chronic obstructive pulmonary disease; CV, cardiovascular; HR, hazard ratio; IV, intravenous; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; RF, renal failure; SBP, systolic blood pressure.
Supporting Information
| Filename | Description |
|---|---|
| ejhf2820-sup-0001-Supinfo.docxWord 2007 document , 236.9 KB |
Appendix S1. Supporting Information. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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